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by the frequency with which a positive tuberculinreaction is found amongst the general population.Dr. W. R. F. Collis’ has recently produced strongevidence in support of this view. In a study ofeight children suffering with erythema nodosum,five were found to be definitely tuberculous byhistory, clinical findings, positive e Mantoux test,and in three cases by the discovery of tubercle bacilliin the stomach wash-out. The remaining three caseshowever presented no evidence of tuberculosis and theMantoux test was negative in all. But these threecases gave a strongly positive reaction to an intra-dermal injection of hæmolytic streptococcal endo-

toxin, a reaction which closely resembled the nodesof erythema nodosum itself. These three cases

followed acute streptococcal sore-throats in from5 to 20 days. Dr. Collis’s work makes it clear that

erythema nodosum is neither a specific disease norinvariably tuberculous in origin, but that the eruptionis the result of the action of the soluble productsof certain organisms on tissues already hyper-sensitive. It is thus possible that it may occur inother infections besides those due to the tuberclebacillus and haemolytic streptococci.

THE SCHÜLLER-CHRISTIAN SYNDROME.THE association of growths in the membrane bones

of the cranium with diabetes insipidus and exoph-thalmos was first ascribed to some form of dys-pituitrism, but of recent years the tendency hasbeen to place it in the group of general metabolicdisorders. In this group there are already suchmaladies as Gaucher’s disease in which the chemicaldisturbance appears to affect kerasin, the Niemann-Pick disease in which phosphatide is incriminated,and perhaps here should be included a curious formof hepatic enlargement associated with excessivedeposition of glycogen as described by Gierke.2 In a recent account 3 of an example of the Schiiller-Christian syndrome by Dr. R. Attig of the UniversityChildren’s Clinic in Berlin, the author refers brieflyto these other defective storage diseases before

proceeding to describe his case under the title of

generalised xanthomatosis, cholesterol being citedas the chemical substance affected in this condition.The patient was a boy of 3! years who had beenperfectly well until a year previously when he fellout of bed and three weeks later developed a tumourin the neighbourhood of the left temple with pro-trusion of the left eyeball. The exophthalmosbecame less in the next few weeks but the bonytumour remained stationary. Shortly afterwards theboy was noticed to be limping with his left leg andabout a year later a swelling appeared at the rootof the nose which led to his coming under hospitalobservation. Swellings were found on the skullin several situations and radiological examinationshowed the curious areas of defective bone describedby Christian as giving a moth-eaten appearanceto the picture and by Attig as being like a map.Changes were also found in the left iliac bone. Theblood cholesterol was raised to 244 mg. per 100 c.cm.and on the skin of the back between the shoulder-blades there were numerous small papules of varyingsize and of a reddish-brown colour. The swellingin the neighbourhood of the glabella was puncturedwithout result and a small piece was removed forsection. It was of a definitely yellow tint and on

1 Quart. Jour. Med., January, 1932, p. 141.2 Zieglers Beitr. z. Path. Anat., 1929, lxxxii., 497.

3 Jahrb. f. Kinderh., 1932, cxxxiv., 196.

examination showed the large foam-cells, character--istic of the disease, which contained a substance-doubly refractive to polarised light. The histologicalexamination indicated that the tumour was a

xanthoma. While the child was in hospital thetumours in the scalp got bigger while the skin conditionbecame more widespread and numerous punctiformhaemorrhages also appeared in the skin. Deathoccurred four months after admission and post-mortem examination confirmed the xanthomatousnature of the changes in the flat bones (skull andilium), the long bones being free. The exophthalmospresent at the onset of the disorder was found tohave been due to a xanthoma of the dura mater.The lymphatic glands throughout the body containednumerous haemorrhages. The cause of the conditionis unknown, although trauma is not infrequent in thehistory of the onset, as in the case here described.The affection of the flat bones, the onset in a childabout two years of age, the skin changes and th&

exophthalmos, all characteristic of the Schuller-Christian disease, were present in this case; but thecurious association with diabetes insipidus, presentin some of the published cases, was absent, probablybecause there were no marked changes in the bones.in the region of the sella turcica.

ANOTHER VIEW OF ARTERIO-SCLEROSIS.

ARTERIo-sCLEROSiS has certainly not been neglectedby clinicians and experimenters, but it is still anobscure condition. Any thoughtful work on it istherefore welcome, and it is all to the good thatProf. Plesch, in the paper printed elsewhere in thisissue, makes suggestions that will not be generallyaccepted at first sight. It seems to be agreed thatarterio-sclerosis, or athero-sclerosis, is a manifestationof a general systemic disease, but the stages leadingup to it are not established, and it is on this pointthat Plesch has definite theories. He advances theview that athero-sclerosis is a healing process in thatit serves no other purpose than to raise the resistanceof the walls of already damaged vessels at points ofstress or strain, the muscular and elastic elementsof the walls of the blood-vessels being previouslyweakened by an atonic state of the vessel. He setsout to prove his thesis by experimental work,together with clinical and pathological investigations.By a process which he himself has perfected he hasinjected the coronary arteries, and remarks on theirregularity of their calibre as a result of dilatation;in this connexion it is of interest to note that

ophthalmic surgeons rely more on the irregularityof calibre of the retinal vessels as indicating vasculardisease than on any other sign found in the fundus.If Plesch’s theories are correct he will provide uswith an explanation of the failure clinically of drasticlowering of the blood pressure or constant use ofvasodilators in the treatment of high blood pressure.There are many who will disagree with Prof.

Plesch when he says that most athletes die beforethey are 50 years of age, and that they are seldomcapable of great physical exertion when they attainmiddlelife. Possibly this statement needs qualifying,and he is no doubt referring to those who give theirwhole time to athletics, and not to those who takepart in sport merely as a recreation. Much workhas been done on the effect of exercise on blood

pressure, and it is pretty generally agreed thatexercise raises the systolic pressure considerably,and the diastolic to a less extent, thus increasing thepulse pressure ; the systolic pressure remains high

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for a considerable time after the exercise is finished,and slowly returns to normal. This is not considered

injurious, and Paul White, in his book on " HeartDisease,’’ says that recent studies indicate that.athletes do not suffer early disability or death becauseof their exercise in youth ; even veteran Marathonrunners have not shown enough hypertrophy of theheart to be evident on radiographic examination.When such conflicting views are expressed, it seemsnecessary to have more precise knowledge on this

important subject, more especially as athletics are

playing an increasingly important part in everydaylife.

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DRAUGHTS AND COLDS.

King Alfred, so Chesterton informs us, " foughtas gravely as a good child at play " ; and it is in asimilar spirit that C.-E. A. Winslow and LeonardGreenburg have approached the study of VasomotorReactions to Localised Drafts.’- Their inquiry wasundertaken " to determine the changes in distributionof the superficial blood-supply resulting from localiseddrafts, with special view to the possible effects ofthese changes upon the condition of the upperrespiratory tract." There is certainly precedentfor this endeavour, and they are able to give animpressive list of workers who have already investi-gated the truth of the popular belief that one cancatch cold by sitting in a draught. Leonard Hilland F. F. Muecke,2 it appears, using the methodof direct observation with a nasal speculum, werethe first to report the fact that in a warm atmos-

phere the mucous membrane of the nose becamemoist and hypersemic, and in a cold atmospherecontracted and ischsemic; on sudden chilling,however, the membranes were often found to remainswollen but ischaemic. It is this abnormal conditionwhere the swollen, spongy tissue lacks the protectiveeffect of an ample blood-supply, which is thought tofavour bacterial invasion.Winslow and Greenburg have adopted elaborate

methods to decide whether localised draughts playa more definite part than generalised chilling in theetiology of respiratory infection. Seven different

subjects, students of Yale University, submittedto a total of 26 experiments. Low temperatureswere secured, in the room used for experiment,by opening the windows and turning off the radiatorson the preceding night, and high temperatures byturning on the radiators and closing the windows.

. The experiments were performed with the windowsclosed to ensure known conditions within the room.On entering in the morning, the subject strippedhimself and lay on a cot for 45 to 60 minutes, afterwhich the following observations were made : the

dry and wet-bulb temperature of the atmosphere ;the cooling power of the atmosphere by the kata-thermometer ; Glatzel mirror observation on thenose of the subject ; visual observation of the swelling,redness and moisture of the nose and throat ; pulse,respiration, and blood pressure ; skin temperatureon the surface of the body, and temperature observa-tions on the nose and throat. He was invitedto say whether he was comfortable or not.

Temperatures were taken at five points in the oral andnasal cavities and at 17 points on the outer skin,and were measured by the thermoelectric method.When these observations were complete a yoke ofbeaver board partition was used to isolate the subject’shead or feet, and the extremity chosen was then

1 Amer. Jour. of Hyg., January, 1932, p. 1.2 THE LANCET, 1913, i., 1291.

, exposed to a draught of air from an electric fan for a. period of 30 to 50 minutes ; the previous observationswere then repeated, with the difference that the

; temperature and kata-thermometer readings were

taken both in the vicinity of the body and of theL isolated extremity. The draught was then dis-

continued, and after a period of 5 to 50 minutes the, complete series of observations was once more

; repeated.; The results of the inquiry confirmed those of

other workers in showing that chilling of the body, surface leads to contraction, ischæmia, and dryness

of the mucous membranes of the nose ; but therewas nothing to indicate that localised, as opposed togeneral, draughts had any special influence on respira-

j tory infection. Only one of the subjects developedS

a cold during the experiments. On this occasion,therefore, tradition appears to have been routed.

. But those who think they can produce immediate; rhinorrhoea by walking barefoot on cold floors may

still feel a little dissatisfied with the evidence againstthem.

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STEENSEN.’ THE Copenhagen Medical Society, taking, we learn,

as their model the British habit, have decided to.

honour prominent men of medicine by institutingcommemorative ceremonies, and as a commencement

. an Oration has been founded in honour of NielsSteensen, more familiar to us as Stensen or Steno,

the discoverer of Steno’s duct. In Holland as well.

as in Denmark the great physiologist is known byhis Danish name Steensen. The first SteensenOration was delivered on Jan. llth by Dr. V. Meisen,

, well known for his surgical work on varicose veinsand haemorrhoids, an ardent student of medical

history, and the translator recently into Danishoi riarveys s ae MotuCordis. Steensen’s life,as set out by Dr.Meisen, is of greatpsychological interest.He discovered in 1660the excretory duct ofthe parotid, when hewas only 22 years old,and was studying inAmsterdam. This wasthe commencement ofan unfortunately shortcareer as a physiolo-gist, but during thenext 14 years heshowed himself a bril-liant investigator ;Michael Foster hasreferred with apprecia-tion to his researchesinto the physiology ofthe muscles, of variousglands, and of the brain, while Dr. Meisen statedin his address that Steensen was the first to showthat the heart was " a muscle and nothing else."He says of the work on the lacrymal glands,that "it explained their structure, working, and

functions ; maintaining that the ducts were theoutlet of the tears, the normal function of whichwas to keep the surface of the eye and eyelidssmooth, and that the passage was only insufficientwhen the lacrymal fluid was secreted in excessiveabundance." In fact Steensen disposed of the

accepted belief that the tears emanated directly from